Patient Care Feedback Survey

Medavie Health Services West is committed to the communities and people we serve. We strive to provide
the highest quality of service to each and every patient in our care. To maintain a high
quality of service and to better meet the ongoing needs of our patients, we would like to
ask for feedback regarding your recent interactions with our service. If you have recently
interacted with our ambulance service, either as a patient or as one associated with a
patient, please take the time to complete and return this survey. Your feedback is
valuable and will provide constructive criticism to help improve our patient interactions.

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* 1. Were you a patient on the ambulance? If no, please explain your connection.

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* 2. How was the response time of the Ambulance?

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* 3. How well did the Paramedics explain what they were doing?

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* 4. How would you rate the Paramedic's concern for the patient's safety?

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* 5. How was the quality of care provided to the patient?

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* 6. What date was the event leading to this survey, for which Prairie EMS Paramedical services were used by the patient?

Date / Time

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* 7. Do you have any other comments, questions, or concerns?

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